Syncope and near-syncope are great diagnostic challenges in medicine.
On the one hand, the symptom may result from a benign condition and pose little
or no threat to health other than that related to falling. On the other hand,
syncope or near-syncope can be the manifestation of a serious underlying condition
that poses an imminent threat to life. Patients with a cardiac cause of syncope
are at far greater risk of dying in the first year after an episode of syncope
or near-syncope than individuals with a noncardiac cause. A cardiac cause
of syncope should be considered in every patient with syncope or near-syncope,
but it is particularly common in older patients or in patients with known
structural heart disease, arrhythmia, or certain electrocardiographic abnormalities.
Although many diagnostic tests may be helpful in the evaluation of syncope
and near-syncope, the history, physical examination, and electrocardiogram
pinpoint the cause in many circumstances. Syncope after exercise may be due
to left ventricular outflow tract obstruction from aortic stenosis or hypertrophic
obstructive cardiomyopathy but can also suggest the diagnosis of postexercise
hypotension in which an abnormality in autonomic regulation of vascular tone
or heart rate results in vasodilation or bradycardia after moderate-intensity
aerobic activity. The patient discussed in this case highlights the importance
of the clinical history in the evaluation of this condition, since the diagnosis
was revealed as the patient's story was described and eventually acted out.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.